Estimating Acute Viral Hepatitis Infections From Nationally Reported Cases

Objectives. Because only a fraction of patients with acute viral hepatitis A, B, and C are reported through national surveillance to the Centers for Disease Control and Prevention, we estimated the true numbers.Methods. We applied a simple probabilistic model to estimate the fraction of patients with acute hepatitis A, hepatitis B, and hepatitis C who would have been symptomatic, would have sought health care tests, and would have been reported to health officials in 2011.Results. For hepatitis A, the frequencies of symptoms (85%), care seeking (88%), and reporting (69%) yielded an estimate of 2730 infections (2.0 infections per reported case). For hepatitis B, the frequencies of symptoms (39%), care seeking (88%), and reporting (45%) indicated 18 730 infections (6.5 infections per reported case). For hepatitis C, the frequency of symptoms among injection drug users (13%) and those infected otherwise (48%), proportion seeking care (88%), and percentage reported (53%) indicated 17 100 infections (12.3 infections per reported case).Conclusions. These adjustment factors will allow state and local health authorities to estimate acute hepatitis infections locally and plan prevention activities accordingly.Infection with hepatitis A, B, and C (HAV, HBV, and HCV, respectively) remains a substantial health problem in the United States.1–3 Chronic HBV4 and HCV5 infections currently affect more than 4 million US residents and now account for more deaths than does HIV/AIDS.6 New HAV and HBV infections have been prevented by the adoption of universal infant vaccination in the United States, but acute infections continue to occur and cause substantial morbidity and mortality.7 Monitoring case patients with acute HAV, HBV, and HCV is important for several reasons. Identifying individuals with acute infections serves to describe modes of transmission and to detect and control outbreaks. Furthermore, prevention interventions of various types—for example, vaccinating susceptible persons, getting injection drug users into treatment programs, treating persons who are chronically infected to prevent secondary transmission, and preventing complications—require ongoing surveillance and analysis of individuals with acute infections of these 3 viruses.Only a fraction of individuals with acute infections of these 3 viruses are reported eventually to the Centers for Disease Control and Prevention (CDC) in the United States. Barriers to ascertaining and reporting hepatitis infections are many, often reflecting the ability of and resources allotted to the local and state health jurisdictions monitoring them. Natural barriers include the following: most individuals with acute infections of any of the 3 viruses are asymptomatic, only some of those with symptoms seek medical care and testing, and even of those diagnosed, some fraction is not reported or enumerated. Complete reporting of, at a minimum, symptomatic case patients is essential because only by identifying them can interventions be implemented to limit disease in the community. Outbreaks are most often detected from the identification of symptomatic case patients.Currently, the CDC estimates incident HAV, HBV, and HCV infections using reports of case patients to develop adjustments through 3 simple probabilistic multiplier models; however, the methods used to develop the estimating factors (multipliers) are outdated and have never been well described or publicly available. Thus, our goal was to update estimates of the number of individuals with acute infections using 2011 reports of case patients.     

A Mentoring Program for the Promotion of Sexual Health Among Korean Adolescents

The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test–post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.     

贵州省居民艾滋病自愿咨询检测相关知识、态度和经历研究

[目的]了解艾滋病综合防治示范区和非示范区群众艾滋病自愿咨询检测相关的知识、态度和经历,为开展艾滋病自愿咨询检测项目提供依据。[方法]采用与规模大小成比例（PPS）的两阶段抽样法在示范区和非示范区分别抽取了500名和512名居民,由调查员对调查对象进行一对一的问卷调查。[结果]示范区和非示范区普通群众对艾滋病自愿咨询检测的认识水平不高,态度有待转变,有过艾滋病检测和咨询经历的人很少。[结论]应进一步加大针对艾滋病和自愿咨询检测的宣传力度,采取多种模式共存的检测与咨询策略,以更多地发现感染者。     

HIV活载体疫苗临床试验进展

自1983年发现HIV-1病毒以来,安全有效的疫苗一直被认为是战胜艾滋病最有效的武器。亚单位疫苗、多肽疫苗、DNA疫苗、各类病毒、细菌活载体疫苗以及不同类型疫苗联合使用的免疫策略等都被广泛应用于HIV疫苗的研究中。其中活载体疫苗由于载体（病毒或细菌）感染而产生的一些细胞因子和趋化因子可能具有佐剂效应,而且活载体疫苗能够在胞内表达HIV抗原,     

河南省2010--2011年新确证病例HIV-1耐药毒株传播调查

参照WHO提出的HIV-1耐药警戒线方案,与中国疾病预防控制中心性病艾滋病预防控制中心合作开展调查,以评价2010-2011年度河南省HIV-1耐药毒株在新确证未经抗病毒治疗病例中的传播水平.     

云南省德宏州2014年HIV-1耐药传播警戒线调查

目的 调查2014年云南省德宏州未经抗病毒治疗的HIV感染者的耐药株传播水平。方法 2014年1-8月在德宏州收集70份新报告的16~25岁HIV-1感染者的血浆样品,对符合耐药警戒线调查要求的58份样品进行HIV-1基因型耐药检测和耐药株传播水平分析。结果 50份样品完成了基因型及耐药鉴定,中国籍占34.0%,缅甸籍占66.0%。通过进化分析对pol区进行分型,主要的基因型包括CRF01_AE、C亚型、URFs、CRF62_BC、CRF08_BC、CRF07_BC、CRF64_BC、B亚型和CRF55_01B,分别占28.0%、20.0%、20.0%、10.0%、8.0%、4.0%、4.0%、4.0%和2.0%。在1个序列中检测到1个针对蛋白酶抑制剂类药物的耐药突变位点(M46I),按照耐药警戒线的统计方法估算耐药株流行率<5%。结论 德宏州16~25岁新报告的HIV-1感染人群中外籍比例较高,HIV新型重组开始传播,但HIV-1耐药性传播尚处于低度水平。     

Estimating HIV Incidence Rates among MSM in an Urban Area of Chongqing Using Three Approaches

<正>To evaluate the HIV pandemic in Chongqing,the pooled PCR,Ig G‐capture BED enzyme immunoassay(BED‐CEIA),and cohort observations were used to estimate the HIV incidences among men who have sex with men(MSM).617 MSM subjects completed the survey at a voluntary counseling and testing(VCT)site.The observed HIV incidence was 12.5 per 100 P‐Ys(95%CI=9.1‐15.7).The annual acute HIV infection(AHI)incidence estimated by pooled PCR was 14.0%(95%CI=     

Feasibility of an internet-based HIV testing service: anonymous urine collection from men who have sex with men

A large proportion of people who are HIV positive do not know their serostatus because facility-based provider-initiated HIV testing and counseling, and voluntary counseling and testing, have not been efficiently implemented in China. Therefore, a new HIV testing strategy must be developed to improve testing services so that more HIV infections can be detected earlier. In this study, we established an anonymous internet-aided urine-based HIV testing service for men who have sex with men (MSM) from 1 April 2016 to 20 January 2017. In total, 3092 urine sample collection packs were distributed by grassroots organizations to MSM; 1977 (69.3%) packs were mailed back to the laboratory; and 1911 (96.7%) eligible samples were tested for HIV antibody. The rate of HIV antibody positivity was 7.1% (135/1901), excluding 10 previously-identified HIV infections. Of those tested, 65.4% (1243/1901) participants obtained their results from our website, 94 (69.6%) of 135 newly-identified urine HIV antibody-positive participants were contacted by CDC staff, and 61.7% (58/94) reported undergoing blood HIV antibody confirmation testing after learning of their urine HIV antibody test results. Of those who were tested for venous HIV antibody, 84.5% (49/58) reported being confirmed HIV antibody positive. Thirty-six of the newly diagnosed participants were successfully referred to a hospital to receive antiretroviral therapy. The rate of confirmed HIV antibody positivity was estimated to be 72.8–89.2 times of that of routine HIV antibody testing. In conclusion, this approach offers an alternative efficient HIV testing strategy to identify HIV positive persons in vulnerable populations.     

我国艾滋病抗病毒药品年度需求预测方法探讨

目的探讨合理预测抗病毒药品年度需求的方法及其影响因素。方法应用世界卫生组织的标准需求模型和经验需求模型预测药品需求公式中的参数。下年度某药品需求量=下年度预计正在治疗的人数×预计某药物的使用人数百分比×用量/天×365天×(1+缓冲百分比)-该药品的库存剩余数量。结果以过去三年的抗病毒治疗人数线性预测,2011、2012年在治人数分别约为8.69万和10.30万,考虑到近年正加大工作力度提高治疗覆盖率,未来两年的在治人数将更多。未来两年内拉米夫定的使用比例约为100%,齐多夫定、替诺福韦、依非韦伦的使用比例将分别在49%~60%、6%~20%、26%~30%范围内逐渐增加;司他夫定和奈韦拉平的使用比例将分别在20%~41%和50%~64%范围内逐渐减少。缓冲百分比一般为25%。艾滋病抗病毒药品的需求受治疗指南,政策资金支持,工作开展力度等多方面影响。结论药品需求预测时需综合考虑多方面因素,将标准需求模型与经验需求模型相结合,力求更为准确地预测药品需求。     

在中国资源有限地区进行艾滋病研究的实验室质量控制

目的通过对中国艾滋病综合研究项目在山西、云南现场实验室质量保证及质量控制实施情况的分析,总结经验,为今后在资源有限地区实验室开展质量控制的运行模式提供可借鉴经验。方法由中心实验室对现场7个实验室直接实施质控,包括标准操作程序(SOP)建立、参加能力验证(PT)、现场实时插入质控品及抽样检测等多种方式,检测数据由第三方核实比对,再由中心实验室分析判定检测结果的有效性。结果现场实验室完成百余份SOP及质量保证/质量控制(QA/QC)方案的建立,所有检测项目均参加并通过PT考核;预实验中有4份丙型肝炎病毒(HCV)插入质控品、2份HCV抽检样品,现场实验室的检测结果与预期结果相反。其余检测现场实验室与预期结果一致。结论由中心实验室直接对现场实施质控、多种质控手段并行,这种质控模式对在资源有限地区按照国际标准进行艾滋病研究是非常有效的,中心实验室的设立对结果的有效、可靠提供了保障。